90837 CPT Code: Complete Guide for Therapists

90837 is the code for extended therapy sessions—53 minutes or more. It commands higher reimbursement than 90834, but also attracts more scrutiny. Use it appropriately for genuinely extended sessions, and your claims will be paid without issue. Use it as a default when sessions don't actually exceed 52 minutes, and you're courting audit trouble.

This guide covers when 90837 is appropriate, documentation requirements, and how to avoid the upcoding trap.

90837 at a Glance

When to Use 90837

Use 90837 when you provide 53 minutes or more of face-to-face psychotherapy with an individual client.

Appropriate scenarios:

• EMDR sessions (often 60-90 minutes)
• Intensive trauma processing
• Complex cases requiring extended exploration
• Sessions with significant crisis content
• Prolonged exposure therapy sessions
• Extended intake/assessment combined with therapy

Not appropriate:

• Standard 45-50 minute sessions
• Sessions you'd like to bill at a higher rate
• Sessions where you spent extra time on documentation

Time Requirements

The 53-Minute Threshold

The boundary is firm:

• 52 minutes = 90834
• 53 minutes = 90837

There's no rounding. Document your time precisely.

What Counts

Included in psychotherapy time:

• Face-to-face therapeutic interaction
• All psychotherapy interventions
• Crisis intervention during session
• In-session assessment related to therapy

Not included:

• Pre-session preparation
• Post-session documentation
• Phone calls to other providers
• Scheduling, billing discussions
• Time client spends completing paperwork

Time Documentation

Precise time documentation is critical for 90837:

Good: "Session: 1:00 PM - 2:05 PM (65 minutes face-to-face psychotherapy)"

Bad: "Extended session, approximately 60 minutes"

Auditors specifically look at 90837 claims. Vague time documentation invites requests for additional information—or denials.

Why 90837 Gets Scrutinized

Insurance payers know that 90837 is frequently misused. Common red flags they watch for:

High 90837 ratio: If 80% of your claims are 90837, that's unusual. Most practices bill primarily 90834.

Consistent 53-minute sessions: Sessions that always run exactly 53-55 minutes look like providers billing the minimum to qualify for 90837.

90837 without clinical justification: Extended sessions should have documentation explaining why extended time was needed.

90837 for straightforward presentations: Mild anxiety with steady progress may not support weekly 60-minute sessions.

Documentation Requirements

90837 documentation should include everything required for 90834, plus additional justification for extended time. Your progress notes should follow a structured format such as DAP or SOAP to meet billing requirements.

Standard Elements

1. Date of service
2. Exact start and stop time (critical)
3. Total face-to-face psychotherapy time (must show 53+)
4. ICD-10 diagnosis code
5. Presenting concerns
6. Interventions used
7. Client response
8. Progress toward goals
9. Plan for continued treatment
10. Signature and credentials

Additional for 90837: Clinical Justification

Your documentation should answer: Why did this session need to be longer than standard?

Appropriate justifications:

• "Extended session for EMDR processing; client processed traumatic memory requiring additional time for closure and stabilization"
• "Crisis presentation requiring extended time for safety assessment and stabilization"
• "Complex trauma processing—client disclosed new traumatic material requiring careful pacing"
• "First EMDR reprocessing session; protocol requires extended time for setup, processing, and closure"

Weak justifications:

• "Client wanted to talk longer"
• "Had extra time in schedule"
• No justification at all

Sample Documentation

90837 vs. 90834: Decision Guide

When in doubt: If your session ran 50 minutes, bill 90834. If it ran 65 minutes with documented clinical rationale, bill 90837.

The Upcoding Problem

Upcoding means billing a higher-reimbursement code than the service supports. Billing 90837 for a 48-minute session is upcoding.

Why Therapists Upcode

• Higher reimbursement (~$30-50 more per session)
• "Close enough" thinking
• Poor time tracking
• Belief that documentation time counts
• Intentional fraud (rare but exists)

Consequences of Upcoding

Protection

• Track time accurately (use a timer if needed)
• Document exact start and stop times
• Bill the code that matches your time
• When borderline (50-53 min), default to 90834

Add-On Code: 90840

When Sessions Exceed 90837

If a crisis session runs significantly longer than 53 minutes, you may add 90840:

90840 — Psychotherapy for crisis, add-on

Requirements:

• Client is in crisis
• Extended time is medically necessary
• Billed in 30-minute increments
• Must be billed with 90837 (not 90832 or 90834)

Example:

• Client arrives in acute suicidal crisis
• Session runs 95 minutes
• Bill: 90837 + 90840

Documentation: Must clearly establish crisis nature and necessity for extended time.

Caution: 90840 is for genuine crises. Regular use will trigger audits.

Telehealth Billing for 90837

When providing 90837 via telehealth:

Billing: 90837-95 (modifier 95 for synchronous telemedicine)

Place of Service: 10 (telehealth, patient at home)

Additional documentation:

• Platform used (HIPAA-compliant)
• Client identity/location confirmed
• Technology issues, if any

Note: Some EMDR clinicians have found virtual EMDR effective; if providing extended EMDR sessions via telehealth, document the same way as in-person.

Common Scenarios

EMDR Sessions

EMDR often requires 60-90 minute sessions for adequate processing time. 90837 is appropriate and expected for EMDR.

Document:

• Protocol phase (preparation, assessment, desensitization, etc.)
• Target memory and SUD/VOC ratings
• Processing content
• Closure procedures

Prolonged Exposure (PE)

PE imaginal exposure sessions often run 60+ minutes. 90837 is clinically appropriate.

Document:

• Exposure target
• Pre/post SUDS ratings
• Processing discussion
• Homework assigned

Crisis Sessions

When a client presents in crisis, extended time may be necessary for assessment and stabilization.

Document:

• Nature of crisis
• Safety assessment
• Interventions provided
• Stabilization achieved
• Safety plan if applicable

Intake + Therapy

Some clinicians combine comprehensive intake with therapy in the first session, running 75-90 minutes.

Consider:

• 90791 (diagnostic evaluation) may be more appropriate for intake-focused sessions
• If significant therapy is provided, 90837 may be appropriate
• Don't double-bill 90791 + 90837 for the same session without clear differentiation

Payer-Specific Considerations

Medicare

Medicare covers 90837 but reviews patterns. If your Medicare claims are predominantly 90837, expect questions.

Medicaid

Coverage varies by state. Some state Medicaid programs have stricter limits on 90837 or require prior authorization for extended sessions.

Commercial Insurance

Most cover 90837, but some have:

• Per-session caps that effectively limit 90837 value
• Frequency limits (e.g., no more than X extended sessions per month)
• Prior authorization requirements for ongoing 90837 use

Know your contracts.

90837 is legitimate for genuinely extended sessions. Document your time precisely, justify the extended duration clinically, and reserve this code for sessions that actually exceed 52 minutes. Accuracy protects both your reimbursement and your license.